Homonymous visual field defect and retinal thinning after occipital stroke

Abstract

Introduction: Stroke is the most common cause of homonymous visual field defects (VFD). About half of the stroke patients recover from VFD. However, relationship between VFD and retinal changes remains elusive. Purpose:To investigate the association between occurrence of VFD, changes of macular ganglion cell and inner plexiform layer (GCIPL) and its axon retinal nerve fiber layer (RNFL) detected with optical coherence tomography (OCT). Patients and methods:The study consists of retrospective review of medical records and follow-up examinations. Patients with acute occipital stroke were registered. VFD was identified with confrontation and/or perimetry tests at the onset. At follow-up, the patients were examined with visual field tests and OCT measurements.Results: Thirty-six patients met the inclusion criteria. At onset, 26 patients (72%) had VFD. At follow-up >1 year after stroke, 13 patients (36%) had remaining VFD: 5 had homonymous hemianopia, 5 had homonymous quadrantanopia, and 3 had homonymous scotomas. Average thickness of GCIPL and RNFL were significantly reduced in each eye in patients with VFD compared to non-VFD (NVFD) (p < .01 for all comparisons). Thickness of superior and inferior RNFL quadrants was significantly reduced in VFD compared to NVFD (p < .01 for both). Among these 13 patients, 4 had characteristic homonymous quadrant-GCIPL thinning, 2 had characteristic homonymous hemi-GCIPL thinning, and 7 had diffuse GCIPL thinning. Conclusion:GCIPL and RNFL thinning were observed in the patients with VFD. GCIPL thinning appears in two forms: atypical diffuse thinning, or homonymous hemi-GCIPL thinning. Examining GCIPL and RNFL provides easy and reliable objective measures and is therefore proposed to be of predictive value on visual function.

Linked Distinct Multi-modular Brain Connectivity Patterns with Retina Microvascular and Structural Alterations, and Their Correlations with Visual Performance in Thalamic Stroke

“…Nonetheless, no association was seen in the VA of thalamic stroke patients with duration > 6-month and their retinal parameters. Some studies previously reported relationships between VA and GCIPL that was related to the pathophysiology of the disease [49]. We previously showed that thalamic stroke patients with a duration > 6-month had thicker retinal structures compared to patients with a duration ≤ 6-month; we also showed that thinning of the GCIPL thickness was associated with deteriorating vision [20].…”

Distinct alterations of retinal structure between thalamic and extra‐thalamic subcortical infarction patients: A cross‐sectional and longitudinal study

“…It is suggested that structural changes in the retinal structural thicknesses may reflect neurodegeneration in the brain of individuals with stroke. Past studies showed individuals with ischemic stroke had thinner RNFL 10–13 and GCIPL 15,16 thicknesses compared with the control group. Baseline analysis in our study showed thalamic stroke patients had thinner RNFL and GCIPL thicknesses compared with extra‐thalamic stroke patients.…”

“… 2 Since it is widely acknowledged that there is considerable homology in the retina and brain, 3 , 4 and retinal structural thicknesses may reflect cerebral structure, 5 , 6 a strong relationship between retina changes and stroke‐lesioned brain has been reported, that is, retinal secondary neurodegeneration after stroke. 7 , 8 , 9 Previous studies have shown that quantitative changes in the retinal nerve fiber layer (RNFL), 10 , 11 , 12 , 13 ganglion cell complex (GCC) 14 and ganglion cell‐inner plexiform layer (GCIPL), 15 , 16 measured by optical coherence tomography (OCT) tool, are associated with ischemic stroke. Importantly, these reports showed retinal structural thicknesses in ischemic stroke correlate with post‐stroke symptoms.…”

The application of functional imaging in visual field defects: a brief review

“…Their study sought to uncover the connections between these changes and the onset of VFDs. GCIPL and RNFL offer straightforward and dependable objective measurements, and are thus regarded as having predictive value for visual function ( 33 ).…”